To complement the MASSAGE Magazine article, “Infant Massage: Healthy Babies, Happy Families,” , in the March 2013 issue. Article summary: The primary role of the massage therapist in infant massage is as instructor, teaching parents how to massage their babies. In most cases, massage therapists learn the technique on dolls rather than on babies. They then demonstrate for parents using the dolls or, sometimes, a baby. Kate Jordan, an educator and owner of Bodywork for the Childbearing Year, points out massaging an actual infant offers a truer experience since dolls don’t cry, sleep or wiggle.
New moms in the U.S. are bombarded with information about caring for and safeguarding their newborns in the days and months after birth. Not so much attention is given to their unique needs in the postpartum period.
This is different from other parts of the world. A new mother in China, for instance, is cared for in seclusion by family members at home or in a special postnatal hospital setting for a month. In Thailand, a traditional midwife visits every day to massage the new mother and relieve any discomfort. In India, the gai visits her twice daily, massaging both mother and baby with a mixture of turmeric and oil. Many of these women would be shocked to learn that in the U.S., women are expected to return to their normal activities within a few days of giving birth. (This was not always the case: One of the first maternity hospitals in the U.S., the Boston Lying-In Hospital, founded in 1832, was named, like other similar hospitals across the country, after the traditional period of bed rest and cosseting of new mothers called “lying in.”)
Skilled, targeted touch and careful listening skills can give women the support and sanctuary that are culturally dictated for them in other societies. Massage therapy can provide new mothers with the symptom relief and nurturance they need in the early weeks and months after their babies’ births.
In the early postpartum period, a woman may experience significant fatigue; the baby blues; concerns about nursing; abdominal discomfort; muscle aches and pains from pregnancy, her labor or her delivery (especially if a cesarean section); and the physical and emotional stress of caring for a newborn.
All postpartum massage sessions should have a spa-like quality even in a nonspa setting, with emphasis on firm, gentle, nurturing strokes that facilitate vascular and lymphatic flow. A recent Japanese study found mothers who received aromatherapy massage had significantly less fatigue in the weeks after birth.
Breast-feeding concerns can include the quantity and quality of milk a mother is producing, her baby’s ability to nurse and clogged milk ducts. A study in Turkey demonstrated breast massage for nursing mothers could increase the quality of milk; a Korean study showed women experiencing less breast pain, lower sodium in mother’s milk and improved infant suckling with 30 minutes of breast massage in the first 10 days after birth.
Although some clients may resist abdominal massage, it is especially appropriate postpartum. A new mother’s uterus involutes, or shrinks, over a period of four to six weeks, and the skin, muscles and fascia of the abdomen gradually regain elasticity and strength. Regular abdominal massage in the direction of peristalsis helps promote intestinal and bowel function. Carefully applied myofascial release and visceral manipulation can enhance the reorganization of pelvic organs.
During pregnancy, the abdominal muscles have lengthened significantly, thinned and lost their ability to stabilize the pelvis against resistance. It may take as long as eight weeks after birth to restore function in these muscles. While new mothers should be encouraged to walk and initiate isometric abdominal exercise, any flexion exercise with significant torque should be chosen with care to avoid straining the lower back and further accentuating the stretched band of fascia between the two halves of the rectus abdominis.
If a new mother had a C-section, as did nearly 33 percent of mothers in 2011, she will be recovering from abdominal surgery. Abdominal massage should be attempted only for a C-section with no medical complications and by therapists with specialized training in this area.
Whole-body massage is appropriate for all new mothers, with the exception noted above, and should focus on areas of muscular discomfort, in addition to the abdomen and breasts.
Since the venous system is impacted by the pregnancy hormone progesterone, and pregnant women’s blood is more likely to develop blood clots potentially leading to pulmonary embolism, massage of the legs in the eight weeks immediately after birth should avoid deep pressure away from the heart, and any kind of deep or cross-fiber strokes on the calves or inner legs.
New mothers are often delighted with the opportunity to lie in a prone position for massage. Make sure the breasts are properly supported with a breast cushion and be aware of the possibility of milk leakage from a nursing mom.
A post C-section mother may be uncomfortable in the prone position soon after giving birth, and will be better placed in a side-lying position with wedge support under her abdomen for work on her back and pelvis.
In the supine position, it is useful to place a woman’s arms in a W or crucifix position while working on the legs and abdomen as a positional release to relieve stress on the upper back caused by childcare activities like nursing.
Making postpartum massage a supportive and nurturing experience for new mothers contributes to their empowerment as they transition to a new family dynamic. As the therapist applies skillful, appropriate touch to her client, she is modeling the kind of touch a parent may use with a child and provides the context of community support and celebration of the new life this mother has brought into the world.
With this mothering touch, the therapist promotes the parent-child bonding that can be lost in our low-touch, techno-centric culture.
Kate Jordan is the pioneering developer of the Bodywork for the Childbearing Year (www.katejordanseminars.com) advanced certification training in medical massage for pregnancy, and of Strain CounterStrain for Massage Therapists. She has been practicing manual therapy at the Moss Center for Integrative Medicine in La Jolla, California, for more than 30 years.